• Non-Athletic Camp Insurance Questionnaire

  • Applicant is:

  • Camp - Non-Athletic | Year-Round or Seasonal

    Please use Sport Specific Questionnaire for these activities:
    Baseball, Basketball, Bowling, Football (flag), Golf, Martial Arts, Soccer, Softball, Swimming/Diving, Wrestling

  • GENERAL INFORMATION

  • Participants' medical payments: (choose one) Note: Some activities may not be eligible.

  • 2. Please list locations and buildings at each location (List additional locations on separate page)

  • FACILITIES

  • 1. Do you own the facility?
  • 4. Are there bleachers or a grandstand?
  • Rows
  • 4b. If yes, are there railings on the back and sides?
  • 6. Do you sell or rent any equipment to the camp participants?

  • MEDICAL ASSISTANCE

  • 1. Is there an accident/medical policy for participants/members?
  • 2. Are first aid kits available?
  • 3. Is any of your staff certified in:
  • 5. Do you have a written crisis/disaster management plan? (If yes, please provide.)
  • 6. Do you have a written medical emergency plan? (If yes, please provide.)

  • SEXUAL ABUSE -  (If located in Illinois, this section MUST be completed. If located in other states, complete only if you desire coverage.)

  • Rows
  • 2. Does the applicant verify employment/volunteer-related references?
  • 3. Does the applicant conduct personal interviews?
  • Rows
  • 5. Does applicant have supervision plan to monitor staff in day-to-day relationships with clients/children?
  • 6. Does the applicant have knowledge of any incident which could give rise to, or result in, an allegation of sexual abuse?
  • 7. Has there ever been an allegation of sexual abuse made against the insured?

  • CAMP OPERATIONS

  • Rows
  • 5. Is the camp:
  • 7. Are any meals or food provided or sold to participants?
  • 8. Please check any other sports or activities at the camp:
  • Rows
  • 10. Is the camp co-ed?
  • Rows
  • 11. Are participants (or parents) required to sign waivers? (Please attach a copy.)

  • STAFFING

  • Rows
  • Rows
  • 3. Do you employ any medical professionals? (EMT, paramedics, doctors, nurses, therapists)
  • 4. Is any of your staff certified in CPR:

  • CAMP TRAVEL

  • 1. Is there any travel away from the camp?
  • 3. Does the camp own any of the vehicles used?
  • 4. Do you verify that all drivers are properly licensed adults with acceptable MVRs?
  • 5. Is anyone under age 21 allowed to transport participants?
  • 6. Is parent/guardian permission obtained for minors who will be transported?

  • OVERNIGHT CAMPS

  • 1. Do you offer overnight camps?
  • 1e. Do these facilities conform to life safety standards?
  • 1f. Are the premises open to the general public?

  • PROPERTY INSURANCE

  • 1. Do you need Building and/or Content Coverage?
  • Rows
  • 2. Do you need Equipment Coverage?
  • 2a. If yes, total value to insure for?
  • Rows

  • OPTIONAL PROPERTY COVERAGES

  • 1. Do you need Computer Coverage?
  • 2. Do you need Outdoor Sign Coverage?

  • COMMERCIAL CRIME

  • 1. Do you desire coverage for Crime (Employee Dishonesty, Money, Forgery)?

  • COMMERCIAL AUTOMOBILE INSURANCE

  • 1. Does the business title any automobiles or other operating vehicles in the business name?
  • 2. Is insurance coverage needed for owned automobiles?
  • Rows
  • Rows
  • 3. Do any of the employees, owners or officers drive personally owned automobiles/other vehicles in the course of their work?
  • 3b. Do you verify they have liability coverage?

  • COMMERCIAL UMBRELLA

  • 1. Do you need a Commercial Umbrella?

  • DIRECTORS & OFFICERS LIABILITY AND WORKERS' COMPENSATION INSURANCE

  • 1. Do you need Directors and Officers Liability Coverage? (If yes, please contact Kevin Morency.)
  • 2. Do you need Workers Compensation? (If yes, please contact Kevin Morency.)

  • SIGNATURE

  • The information I have provided is true and accurate to the best of my knowledge. I have not willfully concealed or misrepresented any material fact(s) or information. I understand completion of this questionnaire does not compel the company to provide coverage.

  • Questions? 877-244-9090
    Kevin Morency |  kmorency@morencyinsurance.com 

    Morency & Associates Inc.
    141 New Shackle Island Rd, Hendersonville, TN 37075
    Fax: 615-452-6580

    https://sportsprograminsurance.com/

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